Search for tag: "asthma"

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: In the wintertime, if there's an inversion, it's probably a good idea not to exercise outside. And in the summertime, you need to watch out for high ozone levels. Dr. Troy Madsen is an emergency room physician with the University of Utah Health. So that kind of surprised me that in the summertime, I got to watch when I exercise as well. Tell me about ozone and why I should be concerned about it.

Dr. Madsen: You know, you're exactly right. It's one of these things where we figure, "Hey, winter is over. I'm in the clear. I don't see that big, thick layer of pollution sitting over the valley. I'm good to go." But then we hit summertime and the high heat, and then we have this other thing called ozone. It's basically, again, a form of pollution. It forms when just the weather gets really hot so we typically see it on hot days here in Salt Lake City, so that's why it's an issue in the summer. And kind of like that winter weather, it gets trapped in the valley, we get the high ozone levels. Those are also going to cause problems for people in their lungs, particularly if you have sensitive issues like asthma or emphysema.

Interviewer: All right. So in the wintertime you can take a look and see what the particulate matter is. You can do the same thing online to see what the ozone level is for any given day. So if it's yellow or red, what types of things do you see in the ER as a result of that?

Dr. Madsen: So in the summertime, we very, very commonly see a lot of lung issues. It's something I find wintertime usually kind of hits late December as the inversion settles in, people start to come in that have a lot of lung problems, asthma, emphysema where things have flared up. And then there's this spike again in July.

Sometimes it's compounded by forest fires, and sometimes we get local fires or fires where the winds blowing that smoke into the valley. But typically, what will happen is someone who has asthma, who has emphysema, has thought, "Well, I've been outside the last few months. I felt great." They get outside with this poor air quality. It just causes things to flare up where their lungs get really tight, sometimes to the point where they really cannot breathe well at all and they have to come right into the ER.

Interviewer: All right. So if you have some sort of those issues, if it's a hot day in July or August and especially if there's been forest fires in the area, you might want to check that ozone level beforehand. What about healthy people?

Dr. Madsen: So healthy people, I can't say we see them quite as often in the ER. Some cases, I will see people who say, "You know, years ago I had exercised-induced asthma and just for the past couple of weeks, I've just felt really short of breath." And maybe they don't sound really wheezy when I listen to them, so we do other tests to make sure nothing else is going on.

But at the end of the day, I say, "Hey, maybe it's just that asthma that's kind of flared up a little bit with this air quality." But it's not like they really sick. It's more they're just saying, "Hey, what's going on?" Kind of diagnosis of exclusion, we say, "Well, maybe it's the air quality."

Interviewer: Yeah. So that's an interesting point that if normally you exercise and you don't struggle at all and then all of a sudden you're wheezy, you might want to check that ozone.

Dr. Madsen: That's exactly right. And that's probably where it surprises most people. They're thinking, "Hey, I've been exercising for months. I felt great. Now I'm having issues."

Interviewer: So no reason to go to the ER unless it's so bad, you're an asthmatic that you cannot breathe, and it will not release.

Dr. Madsen: That's right. I think if you can manage things at home okay, great. Get in to see your doctor if you need to try some additional medications to control things during high ozone levels. But yeah, if you start getting really tight, trouble breathing, absolutely. Get right into the ER.

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Interviewer: What should you do if someone you know has a very severe asthma attack? We're going to find out next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From the University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Madsen, I want to do a scenario here. If somebody has a very severe asthma attack, and I'm there, what should I do? I would imagine that that person knew they had asthma, and I'd hoped they had an inhaler. Would that be the first place I'd start?

Dr. Madsen: Probably so, but you also have to think, is this someone you just need to call 911 for and get them to the ER. And in my mind, the way I really judge the severity of an asthma attack is, first of all, can the person talk to me? If a person cannot breathe well enough, where they can't really get out more than say a one word answer, that's really severe. And in that situation, before I go looking for their inhaler, I'd say call 911. Get the ambulance there, get them to the ER, because even if they take a couple of puffs of their inhaler, it's probably not going to do much in that situation.

Interviewer: All right, so super severe like that, don't even mess around with it, don't hesitate, call 911, get the professionals there.

Dr. Madsen: I would.

Interviewer: And if they're not quite that severe, they're able to get some sentences out, they're able to talk to you, what would you do at that point?

Dr. Madsen: Usually in that situation, if they have asthma, they have an inhaler somewhere, and so they might say "Hey, can you go grab my inhaler for me?" Maybe they're feeling kind of winded, they just want to sit down, try and relax a little bit. But they're talking to you, they're not breathing so fast they just can't get anything out. You look at them, they look like they're working a little bit to breathe, but it's not like when they breathe you see all of their neck kind of sucking in because they're trying to get air in. So it's not a real severe case, so certainly I think an inhaler is going to help there.

Even in those situations, if it's that bad they might take a couple of puffs of their inhaler, they might feel a little bit better. But I often find even in those scenarios, they may need some more treatments in the ER, including possibly steroids which are going to help out as well, which typically they don't have at home.

Interviewer: All right, one of the ABCs is breathing. And any time that somebody is having trouble breathing, that is one of the rules that you use that you should go to the ER. So it's crucially important. What should you do at that point, while you're waiting for help to arrive, whether it's the inhaler didn't work, maybe they didn't have one, they ran out, they are struggling breathing. Is there anything you can do to help them at that point?

Dr. Madsen: Really the best thing you can do is whatever you can do to just keep them calm, because if someone is having trouble breathing, that's going to make you feel anxious. You can just imagine that drive you have to breathe, and when you're struggling with that you're going to feel incredibly anxious. The problem with asthma is that anxiety is going to make it even more difficult to breathe, it's just going to compound the problem.

So realistically, the only thing you can do there besides say having them take some puffs of their inhaler, would be to do whatever you can do to help them calm down. Turn on the TV, turn on some music, something just to help them relax a little bit, while you're waiting for the ambulance. Reassure them they're going to be fine, tell them you're breathing okay, you're talking to me, this is great, ambulance should be there hopefully within 5 to 10 minutes. And at that point, they're going to get them on some continuous breathing treatments and get them where they need to be.

Interviewer: So in summer, it sounds like if somebody is having a severe attack like that, just call 911 because there are things that you can do in the emergency room to help them, and just a breathing problem is not something you want to mess with.

Dr. Madsen: That's exactly right. Like you said, we talk about the ABCs, that's what B stands for. Once you talk about breathing, you've got to address it, and usually you're not going to be successful at home. Keep in mind that asthma is a very serious disease. It kills thousands of people every year, so you have to take it seriously to get them the help they need.

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Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to ER or Not on The Scope.

Interviewer: It's time for another edition of ER or Not, it's a game where you get to play along and determine whether a condition that we've talk about here warrants a trip to the ER or not? Today, we're with Dr. Troy Madsen as always. He's an emergency room physician at University of Utah Health Care. All right the scenario today is difficulty breathing. What do you think? ER or not?

Dr. Madsen: So difficulty breathing. So when we talk about issues that we had seen in the ER, my thought process is ABC. First thing is airway, and the second thing is breathing. So if you're having difficulty breathing, for me that is absolutely reason to go to the ER, and when I hear someone that's having difficulty breathing I think of a number of things.

Maybe they have asthma, maybe they've had an allergic reaction that's closing off their airway and making their lungs tight. Maybe they have a blood clot in their lungs, maybe they have heart failure, maybe they have a heart attack. All these things are serious things, these are not things you're going to be taking lightly. You're not going to call your doctor and say, "Hey, I'm having difficulty breathing can I get an appointment in a week?"

If this is something that's come on suddenly, you're having trouble getting deep breaths in, you feel shorter breath, your lungs feel tight, your throat feels tight, those are absolutely reasons not only to go to the ER but you may even consider calling 911.

Interviewer: Wow. So any difficulty breathing is probably something you need to take seriously?

Dr. Madsen: It is something you need to take seriously.

Interviewer: I know. I'm trying to make that very all inclusive.

Dr. Madsen: Yeah.

Interviewer: I mean is it?

Dr. Madsen: I don't want to tell you to call 911 right off the bat. Maybe you have a history of asthma and you're familiar with this and you've been exercising, and it's cold outside and your lungs feel a little bit tight and you know you've had experienced with it. You know if you use your inhaler, your lungs are going to open up, you're going to feel fine. I mean that's one kind of example there.

But here I think we're talking more about the person who typically is not used to having this throat tightness or lung tightness and suddenly they feel their lungs are tight, their throat is tight, they can't get a deep breath, that's the reason to get to the ER. Again, depending how severe it is, even call 911 or have a family member call 911 to go by ambulance.

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Dr. Jones: Fish oil in pregnancy decreases the risk of childhood asthma? Really? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is a true fish story on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Pregnant women have had mixed signals from science about how much fish to eat during pregnancy. The concern is that some fish have high levels of mercury, which is bad for the developing child. On the other hand, there are lots of studies that say fish in the diet, specifically the oils in cold-water fish, are good for the developing child-to-be.

The incidence of childhood asthma has doubled in the developing world in the last 20 years. There are lots of reasons proposed for this, maternal diet, decreased incidence of vaginal birth, not letting our kids play in the dirt and letting the dog lick their face to name a few, and we've discussed these on The Scope.

It's been known for some years that children who eat more fish, who have a diet enriched in Omega-3 fatty acids, have a lower risk of asthma. The proper term for what is lacking in the American diet in the fats direction is long-term polyunsaturated fatty acids, LCPUFAs, or specifically, eicosapentaenoic acid and docosahexaenoic acid, or EPA and DHA for short. And the EPA and the DHA are all that you non-biochemists need to remember.

So observational studies, who eats what and how do their babies turn out, suggest that moms who ate more fish had babies with less asthma. Okay. But association, fish and lower risk of asthma, doesn't mean causation, fish oil prevents asthma. Just published and making all the news is a pretty big, meaning 736 pregnant women, randomized trial starting at 24 weeks of pregnancy comparing fish oil and placebo, which was olive oil, in capsules during pregnancy and following the kids that were born for five years. Neither the moms who took the capsules during pregnancy nor the docs who followed the kids knew what capsule the pregnant moms got.

Now, as an occasional consumer of fish oil, I can tell you that you know by your fishy burps if you've taken fish oil, but they didn't even mention that in the New England Journal of Medicine publication. They should have asked me if you can really blind people to fish oil or olive oil.

Anyway, the study found a 30% reduction in the incidence of childhood wheezing, and that's a pretty big thing. Kids of moms who took fish oil had a 17% incidence of wheezing and asthma, and the kids of moms who took placebo, which was the olive oil, had a 24% incidence. The coolest part of this study is they actually measured the levels of EPA and DHA in the moms before they started the study and the biggest difference in the incidence of asthma was found in people who had the lowest levels of these molecules and then took the pills.

They also looked at some genetic markers in moms that were associated with lower levels of EPA and DHA. Some people have genes that make it easier to convert plant oils to EPA and DHA. The incident of asthma and wheezing was 34% in the kids whose moms had the lowest levels of EPA and DHA who took placebo. That means one-third of those kids had asthma and only 17% in the moms who took fish oil. That's a big reduction, a 50% reduction. Moms with the highest level of DHA and EPA before the study had just a little difference in the lower asthma, compared to those who took fish oil or those who took olive oil.

This was done in Copenhagen, by the way, so a lot of the moms probably ate more fish than we do in the US. So what is it? Is it the oil or some protein in fish oil that makes the difference? We don't exactly know how this works yet, but the effect of fish oil supplementation was pretty big. For moms with the lowest level of EPA and DHA in their blood, it would only take treating five women during pregnancy to prevent one case of wheezing or asthma in the children. That's a pretty big effect.

Now, what did the moms really take? They took 2.4 grams of fish oil each day. That's about 20 times more than the average American mom gets in her diet daily. I pulled my Trader Joe's Wild Salmon Oil off my shelf and it has 600 mg Omega-3 fatty acids in 1,200 mg of fish oil per capsule. I'd have to take four of them a day to get the same dose. Then I looked at my can of Wild Planet sustainably pole and line caught wild tuna, and one 5-ounce can has 2,000 mg of DHA and EPA. Now we're getting close, but I have to eat a can a day.

I would eat tuna fish sandwiches or casserole every day if my mother were still here to make them for me. And canned tuna was cheap when we were growing up so we ate a lot of it. My mom had a nutrition background and was always trying to get us to eat fish, but she only succeeded with tuna. She made a totally disgusting casserole with canned salmon called "Salmon Wiggle," that we could barely eat. You can check out the recipe for "Salmon Pea Wiggle" on Google and for whatever reason, I cannot imagine it gets four out of five stars.

So I wouldn't jump in and eat a can of tuna a day starting at 24 weeks, or eat salmon every day or buy a mega bottle of fish oil capsules. However, many pregnant women are already taking supplements of EPA and DHA in pregnancy for what is thought to be a benefit for fetal brains. Maybe there's more to it. In the meantime, some cold-water fish in your diet is good for you and your kids and stay tuned to The Scope.

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Dr. Jones: Good bacteria and bad bacteria. We are being bombarded by information about the bacteria with which we share our bodies, but what about our babies? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University Healthcare, and this is Babies and Good Bacteria on The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: We have previously talked about how babies benefit from exposure to different kinds of bacteria. Babies who have a wider exposure to bacteria may have less obesity, diabetes, asthma and autoimmune disease. So it is okay to put your baby on the floor, and it is okay, mostly, to let your dog lick your baby.

Now, a baby in the uterus the day before it is born is living in a mostly sterile environment. The passage through the mom's birth canal during labor allows mom's bacteria to colonise the baby, and breastfeeding allows some more.

The vaginal bacteria in healthy pregnant women are largely lactobacillus, which is a bacteria that can help babies metabolize milk, but what about babies that are born by cesarean section? There are some data to suggest that babies born by cesarean, and that is about 30% of babies in this country, may have more autoimmune diseases like asthma, type 1 diabetes and other conditions, and food allergies than babies that were squeezed out through the mom's vagina, especially babies that were born via cesarean, without moms having been in labor for a while.

Okay, so it isn't a huge difference in which babies get some diseases, but if you were planning a caesarean, could you do something about it? A short report has just been published in the Journal of Nature Medicine suggesting that you can. This was a very small study of 18 moms and their babies at the University of Puerto Rico in San Juan. Seven babies were born vaginally and 11 babies were born by elective cesarean section without labor.

Four women who were scheduled to have a caesarean had a bit of gauze put in their vagina, then removed and put in a sterile container before the cesarean was performed. A few minutes after the babies were born they were dried off and four of the babies had gauze wiped over their skin. Eleven other babies did not. Over the following month, the moms and their babies had their microbiome, their bacterial ecosystem, assessed. The babies who were treated with the gauze had skin bacteria more like their moms and more like the babies born vaginally. The babies born from cesarean who did not have the gauze treatment had bacteria more like that from the hospital environment, and less like their mom's vaginal environment.

The babies who had the gauze treatment weren't exactly like babies born vaginally in that their gut bacteria weren't as varied and abundant as babies born vaginally. This could be for several reasons. One is the fact that moms getting a cesarean often get antibiotics to decrease the risk of infection in their cesarean incision or their uterus. Infection is relatively common in cesarean incisions, and that is why we give women antibiotics routinely who are having a cesarean.

So lots goes on in labor that involves moms exchanging bacteria with their babies. Now we don't know if these babies with the gauze treatment will grow up to be healthier or not. And we don't know if there are some moms with bacteria or viruses in their vagina that shouldn't be shared with their babies.

A bigger study is ongoing right now at New York Hospital. However, this idea is being disseminated in mothers' blogs and magazines, and women are asking for it. The professional medical organizations haven't recommended it yet, and I am pretty sure I would add the statement, "Don't do this at home," but if you're interested you should ask your OB.

There is so much to think about when you're going to be a new mom, and this wouldn't be number one on my list, but it is something to know as we learn more and more about the world in which we live and into which we bring our babies.

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Dr. Gellner: Even if cats and dogs make you sneeze, will you save your kids from aggravating allergies by getting them a pet? It's a theory we'll discuss today on The Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Early pet exposure reducing the risk of allergies in children. It's part of something called the hygiene hypothesis, and it's been tossed around for a few years now. Evidence is mounting that it may be true. Studies found that exposure to pets in early years of a child's life might significantly lower the risk according to some pediatric allergy specialists.

The allergy researchers followed a group of about 500 children almost equally split between boys and girls from birth to age seven. Children were checked regularly with blood tests to measure antibodies that cause allergies, skin reaction tests that show if someone is sensitive to an allergy, and a breathing test to measure their lung function commonly used to detect if their child has an asthma flare or not.

The researchers also collected information on exposure to cigarette smoke, home and daycare environments and measured allergen levels in the household such as dust and other air samples. They also asked about pets in the home.

So the allergists found that children who lived with two or more animals were significantly less likely to have a positive skin test, which signifies a reaction to the allergen rather than those who had no exposure to pets. Children with pets were also less likely to have allergen antibodies in their blood. Boys especially seem to benefit from pet exposure. Not only did they have lower antibody levels, they had better lung tests and less evidence of asthma if there were two or more cats or dogs in the house.

The study adds to the growing literature about the hygiene hypothesis that the cleaner we live, which is common in our western world lifestyle, the more likely we'll get asthma and allergies. It confirms that observation that children with a history of pet exposure in the first years of life may have less asthma. Boys do tend to get more asthma and allergies, though.

The study falls short of proving that pets can prevent allergies and asthma. You shouldn't automatically just go out and get two dogs and two cats. It's a correlation that may be true but it hasn't been proven yet. It could be that the study shows that only children who have a risk of allergy or asthma tend not to have cats or dogs in the house.

By working on this same hygiene hypothesis, pets may not even be a necessary factor in increasing a child's immunity. Siblings might also play the same role as pets. Infections in early life, especially with viruses, may help drive the immune system away from being sensitive and causing allergies. Kids can get the same kind of exposure from older siblings in the first month of a child's life. Usually the older siblings will bring home lovely viruses from school, or the child themselves will be exposed to viruses at daycare.

Just like we say don't go out and get two dogs or two cats just to keep your kids from getting allergies, we don't necessarily mean you have to put them in daycare in order to expose them to these viruses. More studies need to be done following children in their early lives before any conclusions can be made about the hygiene hypothesis.

So does this mean you should go out and get a pet? Well, not so fast. If there's someone in the house who has an allergy to a dog or cat, you really don't want to put that family member through misery. Also, genetics play a large role as well. Children have a one in three chance of developing allergies if just one of their parents has allergies. If both of their parents have allergies, their risk is nearly 70%. The risks increase by similar amounts for asthma. Pets are a lot of responsibility, too. Be sure to think about all family members, pets included, if considering a dog or cat.

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Dr. Kirtly Parker Jones: "Don't put that in your mouth." How often have we said that our babies on the floor, who picked up the dog's bone and starts to chew on it? We try to keep our infants safe from diseases by keeping them away from anything dirty, by keeping their environment ultra clean. But maybe a little dirt in our infant's beginnings helps them in the future life. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at the University Healthcare, and this is the down and dirty about babies and allergies today on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Kirtly Parker Jones: How does our body learn what the immune system should fight off and what it should accept? The immune starts developing in the womb, but the real work begins at delivery. The bacteria that are very important and populating the newborn's gut comes from the mother's vaginal flora and her skin, and the bacteria the baby experiences is in early life.
Having a lot of different bacteria is a good thing. Babies born by a Caesarean section without labor have more asthma, more autoimmune diseases, and eczema. But what about after birth? We evolved our immune system by living in the dirt, not with hand sanitizer. It's a good thing not to be allergic to your environment, so what is the evidence that we should let our babies suck on their pacifier when it falls in the dirt or chew on the dog's bone? Today, we're going to talk about babies and allergies.
It's long been known that many of the autoimmune diseases that we see in the U.S.; asthma, eczema, autoimmune colitis like Crohn's Disease are very rare in third world countries or, to be politically correct, developing countries. A mounting body of research suggests that exposing infants to germs may offer them greater protection from illnesses such as allergies and asthma later on in life. There's something called the Hygiene Hypothesis which holds that when exposure to parasites, bacteria, and viruses is limited early in life, children face a greater chance of having allergies, asthma, and other diseases later in adulthood. In fact, kids with older siblings who grow up on a farm or who attended daycare early in life seem to show lower rates of allergies.
Just as a baby's brain needs stimulation, input, and interaction to develop normally, the new research is read to your kid from birth, not just put them in front of the TV, the young immune system is strengthened by exposure to everyday germs so that it can learn, adapt, and regulate itself.
It's been observed that infants from farm families, especially those with older siblings, have much less asthma and allergies to pets or other animals. I think old siblings thing is that the older sibling puts their dirty hands on the infant, and this is not such a bad thing, as it turns out. It is innate behavior of infants to pick up everything and put it in their mouths, including their hands, their feet, and anything they can reach. Well, maybe there's a reason for that. They aren't hungry, and adults don't do that. Even children over 3 don't do that anymore. So maybe they are priming their gut with bacteria to help them later in life. That's just a guess.
Recently, it's been shown that bacteria in the newborn's gut are important in regulating the developing immune system. And finally, a new study from John Hopkins looked at asthma in inner city children. Infants were followed from birth to 3 years. Now, we know inner city children have high rates of asthma and triggers include cockroach droppings, mouse, and cat dander. So they tested these children and their homes for these exposures as well as doing a quote "bacterial analysis" of their home. Infants who were exposed to cockroach droppings, mouse, and cat dander and a wide variety of bacteria had a 17% incidence of wheezing by age 3 compared to 51% of wheezing in kids who weren't exposed to these factors as infants. Wheezing in early childhood can be a sign of future asthma in children. The important and curious fact is the exposure has to happen in the first year of life to be protected.
We know that our fear of germs and our babies comes from the knowledge that around the world, the number one killer of newborns is infectious diarrhea from unclean water, so we don't want to expose our kids to bacteria and unclean water and from people who are sick. These germs are sick people germs, not from the environment. We should take care about exposing our infants to people with diarrhea and upper respiratory tract infection, but I'm talking about crawling in the dirt.
So what should we do as moms and grandmas? If the child is otherwise healthy and doesn't already have a compromised immune system from disease, its okay to let the dog lick the baby's face, and the binky doesn't have to be sterilized if it drops in the dirt. Let the infant sit or lay on the ground or the floor. A little dirt won't hurt her none. So that's the down and dirty about babies and their developing immune systems. Stay tuned because this is an area of research that's growing very quickly, and thanks for joining us on The Scope.

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Oh, little bits of dirt that you breathe that get into your body and affect your baby. Air pollution in pregnancy: What do we know and what should you do?

You thought that your lungs filtered out dirt and the placenta filtered out bad stuff? Well, that's sort of true, mostly true, but not completely true. Recently we've had yellow air days and orange air days and even a red day. What does this mean to you if you're pregnant, and what happens to you and your baby on a red-air day? And what can you do about it?

In Utah and across the west, we settled our towns in valleys where there was water. That was a good thing, right? And the towns grew and the cars were invented and industry grew and that was a good thing, right?

Well, we know in the past London, England had some of the worst air quality episodes in the world. And we know that people died when air got that bad. So what's happening in the Salt Lake Valley, a city in a valley prone to air inversions and when you have to breathe what your car and the refineries have pooped? Bad air has a lot of bad stuff to it-ozone, sulfur dioxide, nitrogen dioxide, and particles of incompletely burned stuff, the thing I so inelegantly called poop.

From your cars, from your favorite barbeque place, from the big industries, and from refineries. The incompletely burned particles come in different sizes, but the worrisome ones are very small, and they are called PM2.5 and they are too small for your lungs to clean and they get into your body and inflame your body and your placenta.

It is hard to do research on pregnant women. In fact, we're specifically told we have to be very careful doing research on pregnant women. And it's really hard to put pregnant women into a controlled room and expose them to various amounts of bad air. And some women get good air. And then see what happens to their pregnancies and their babies. We do have research from areas with bad air that look at pregnancy outcomes and children's health. California has been very active and looking at outcomes of pregnancy and bad air. Women exposed to bad air, living close to a freeway when they were pregnant, had smaller babies and more premature babies. And their children had more asthma and more autism.

Can we prove it was the bad air or something else, like freeway noise instead of bad air? This is hard, but here in Utah we had an experiment in Utah County about 20 years ago. We used to have really bad air when Geneva Steel was open, so we could look at outcomes when it was open and when it was closed. One specific outcome, prematurity, was a lot worse when it was open.

So what do you do if you're pregnant in bad air days, on orange days or red days? I'm not suggesting that you get in your car and go to Park City; that just makes air worse. And in recent years, the bad air has traveled up to Park City anyway. So don't drag your bad air up to Park City. You should never use a wood fireplace or wood-burning stove when you're pregnant. The air quality inside is many, many times worse than the worst air day.

I hope staying inside on bad air days helps, but our inside air comes from outside. There is some research that home air filters that can filter PM2.5 might make the air better in your home. There will be more information on this in the future as we get better small air quality measuring devices and the U is funding research just for this purpose.

Don't use your snow blower. It's a very inefficient high polluting engine. Get someone to shovel your snow.

Stay off the road; air quality on bad days is worse next to the freeways. Minimize your trips, not just for you but also for everyone, and don't wait for bad air day to limit your trips. Don't idle your car. The Utah Department of Air Quality has predictions about the next few days; act now to make tomorrow's air better.

Google the Utah Air Department of Air Quality or you can go to Airnow.gov and get a look at the country and click on Utah.

So pay attention to the air quality and the Department of Air Quality's predictions. Be an advocate; let your local and state representatives know that you're very concerned about Utah air quality; you're willing to put up with tighter controls for cars and industry, and you vote. And don't hold your breath; you're breathing for two.

updated: February 18, 2020
originally published: March 13, 2014

Research indicates that if kids are overweight at 5 years old, they have a pretty good chance of being obese adults.

You've heard me talk about it before. Obesity is becoming a really big problem for kids. And there's a lot of things that you need to remember. Obese kids are at risk for diabetes. They have high cholesterol. I see kids already, kids that aren't even 10, and they have insulin resistance, which is pre-diabetes. They have high cholesterol, high triglycerides. I've seen kids who are barely 10, barely into double digits, and they have triglyceride levels double what an adult should have.

If your child is obese and has asthma, it's going to make their asthma worse. A lot of kids will complain that they're short of breath because they're carrying so much weight. They'll have back pain, knee pain, things like that, and they just can't keep up with other kids. So that's the physical problems that go along with obesity.

The psychological ones, that too, a lot of kids who are overweight, they aren't liked by many kids. They're teased by many kids, bullying, and they don't feel good about themselves. You know, it really weighs on their self-esteem.

So it's important as a parent that you pay attention to this and especially pay attention before they become kindergarteners. See your pediatrician and ask them, you know, "What is my child's weight, what is their height, and what is their body mass index?" All kids over 2 can have their body mass index calculated, and it's just a math formula. It takes their height and their weight into consideration, and it comes up with a number. You need to look at their percentage for their body mass index, and if they're over 95 percentile, they're considered in the obese category.

So a new study came out in "The New England Journal of Medicine," and it showed that half of childhood obesity occurred in children who had been overweight during the preschool years. One thing it pointed out was that kindergarteners who were heavy babies, which is 8.8 pounds or more at birth, were actually more prone to being overweight toddlers and overweight kindergarteners.

We usually associate healthy babies with chubby babies. And the realism is I'm not surprised at this study. I'm seeing a lot of kids who are overweight in their toddler years, who get to just graze all the time with eating, whose parents, you know, they think that they just need to constantly be eating for growth. And actually, kids normally go through what's called the toddler appetite slump. Between ages 1 through 5, they just don't eat that much. They're not growing like they were in the first year of life. They're not growing like they will be during their second growth spurt around the kindergarten, first grade years. So they don't need as many calories in as they did before, so they normally are going to thin out by age 4.

For kids who are overweight before kindergarten, it's like they've already gotten their destiny predetermined. One-third of kids who are overweight in kindergarten were actually obese by eighth grade. I mean, that's when they're around 11 years old. And the concerning thing is almost every child remained that way.

So you don't want to wait until they're, you know, in later elementary years or in middle school before you start going, "Hmm, my child looks a little bit more overweight than some of these other kids." You actually want to start paying attention when they're in preschool. See how their weight is in preschool, because that's going to tell you what things are going to be like once they get older.

Once obesity is established early in life, it actually tracks through adulthood. The only time there's really exceptions is when you make a conscious effort to change the eating habits and the activity habits of the children that you're concerned about.

For a lot of kids there is concern about, you know, what is the ethnicity? You know, everyone says, "Oh, well, I'm from this type of ethnic group, and we always are big-boned people." Or, you know, same with race or family income. A lot of people say, "Well, I don't have the family income to be able to afford all these healthy foods, so I'm going to feed them what I can because I want my children to eat." But, regardless, a lot of people say, "Well, that's how it is in my family." But the truth is, after age 5, those factors no longer affect their risk for being overweight in the later years.

So what parents really need to do is focus on checking their child's growth from early on, seeing how they are on the growth curves. And again, your pediatrician will tell you what their growth is, their weight, their height, and, after age 2, their body mass index at every single well visit.

Parents also need to pay attention to what your child is eating and their eating habits. You want to make sure you're instilling healthy eating and activity habits early on before there's a problem. And if you're worried that there might be a problem, the study reinforces that genetic influences do show up early in life, but exercise and a healthy diet can actually reduce the effect of the genes. You can actually overcome your genetics, to a point. Unfortunately, you can't change your genes. You can change how you eat and how you exercise.

So the important thing is to prevent the problems from happening rather than reacting to the problem once they've already happened. Pay attention to 5210, five servings of fruits and vegetables a day, two hours or less of screen-time, television, computers, video games, one hour of physical activity, and it doesn't have to be one hour all at once. You can do 20 minutes here, 10 minutes here, 5 minutes here, round off with a half an hour, just being active. And finally, zero sugary drinks. That includes juice, that includes soda. You will be shocked to find out how much sugar and how many calories are in a 20-ounce bottle of soda or a 12-ounce cup of juice. It's as much as a candy bar. So eliminating the bad stuff like that from the diet, making them treats instead of daily or weekly parts of your diet can actually go a long way to prevent the problems of childhood obesity.

If your child can make it through their first five years at a healthy weight, the chances that they will remain at a healthy weight for the rest of their lives really improves. So it's worth making the effort early on to give them the best start in life that you can.

updated: December 6, 2021
originally published: March 4, 2014